The study aim is to determine the criteria for carotid atherosclerotic plaque instability with the use of an advanced ultrasound technology, immunohistochemical analysis, and electron paramagnetic resonance (EPR) and assess their correlations with histologic results.
A total of 92 patients were included in the study and were examined by ultrasound duplex scanning and ultrasound elastography. Plaques harvested during carotid endarterectomy were obtained for histologic analysis, immunofluorescent assay, and EPR spectroscopic measurements.
Multivariate logistic regression analysis showed that plaques with an area &gt;90mm(odds ratio [OR], 4.05; 95% confidence interval [CI], 1.32-13.2; P=0.006), plaque volume index&gt;0.6cm(OR, 2.72; 95% CI, 1.05-9.58; P=0.04), and juxtaluminal black area ?8mm(OR, 2.82; 95% CI, 1.22-6. 23; P=0.02) were statistically significant independent predictors of histologically verified unstable plaques. Unstable plaques occurred in 94% of the patients with these indicators. Significant increases in the number of CD68+ and CD36+ cells (inflammatory markers) and CD31+ cells (neovasculogenesis markers) were revealed in unstable plaques by the immunohistochemical assay. EPR data analysis showed that divalent manganese could serve as a marker of plaque instability.
Additional ultrasound criteria, verified by histologic studies, significantly increased the information content for identifying patients with unstable plaques, which can be of great importance in stratifying the risk of ischemic stroke, especially in asymptomatic patients. The degree of calcification is not a mandatory criterion for plaque stabilization.
Additional ultrasound criteria, verified by histologic studies, significantly increased the information content for identifying patients with unstable plaques, which can be of great importance in stratifying the risk of ischemic stroke, especially in asymptomatic patients. The degree of calcification is not a mandatory criterion for plaque stabilization.Management of the ischemic diabetic foot (DF) due to infrapopliteal arterial disease is challenging and controversial. Observation, bypass surgery, and endovascular intervention are the 3 available options. Outcome of percutaneous transluminal angioplasty (PTA) versus conservative therapy is evaluated in this prospective study from Sulaymaniyah, Iraq.
Over 2years starting at January 2018, 40 patients with ischemic DF underwent PTA and compared with a control group (n=78) of ischemic DF managed conservatively. Besides clinical assessment, all patients underwent Doppler ultrasonography and computed tomography angiography while conventional angiography was reserved for PTA group. Patients who fulfilled the standard angiographic findings underwent standard PTA, and their outcome was compared with the control group.
Mean age was 64 years; 70% (n=28) were men with a male female ratio of 2.3 1. Renal function was impaired in (n=11, 27.5%), and 7 (17.5%) patients were smokers. The commonest clinical presentation was nonhealing ulcers (n=39, 97.5%), and most patients (n=39, 97.5%) had Fontaine IV and Rutherford V-VI grades. Most lesions were anatomically complex; Trans-Atlantic Inter-Society Consensus C and D types, Graziani class ?4 (75%), long segment (n=28, 70%), and chronic total occlusion (n=26, 65%). Success rate was (n=38, 95%), and no patient died. Ulcer healing was higher (67.5% vs. 34.6%), and ulcer recurrence was lower (20% vs. 47.4%) in PTA group but amputation rate was not significantly different (12.5% vs. 12.8%) (P&lt;0.05).
Although amputation and death rates were not significantly different, endovascular intervention achieved better ulcer healing in ischemic DF compared with the conservative approach.
Although amputation and death rates were not significantly different, endovascular intervention achieved better ulcer healing in ischemic DF compared with the conservative approach.Patients with chronic limb-threatening ischemia (CLTI) at the extremes of age are thought to have distinct risk factor profiles and poor outcomes after lower extremity revascularization (LER). The aim of this study is to examine the relationships among age, risk factor profiles, and outcomes of LER in patients with CLTI in a large database focusing on the extreme age groups.
Patients undergoing LER for CLTI in the Vascular Quality Initiative suprainguinal bypass, infrainguinal bypass, and peripheral vascular intervention files were reviewed through 2019. Patients were stratified into 3 groups premature peripheral artery disease (PAD) (?50years old), 51-84years old, and elderly (?85 years old). Trends in major amputation and mortality by age group were analyzed.
There were 156,513 patients who underwent LER for CLTI. https://www.selleckchem.com/products/omaveloxolone-rta-408.html Of these, 9,063 (5.79%) patients had premature PAD, 131,694 (84.14%) patients were 51-84years old, and 15,756 (10.07%) were elderly. Patients with premature PAD were more likely to have insu the extremes of age have significantly different outcomes after LER for CLTI. Although mortality increases with age, the risk of major amputation decreases. Patients with premature PAD constitute a group of patients with a high risk of perioperative and 1-year major amputation.The gold-standard for management of combined common femoral artery (CFA) and superficial femoral artery (SFA) atherosclerotic occlusive disease has traditionally been open femoral endarterectomy and femoral-popliteal bypass. Hybrid approaches involving an open and endovascular component are increasingly common. The aim of this study was to compare perioperative outcomes in patients who underwent an open versus hybrid revascularization.
NSQIP data, years 2012-2017, were queried for patients who underwent nonemergent CFA endarterectomy with either SFA transluminal intervention or bypass. The primary outcome of interest was a composite of cardiovascular, pulmonary, and renal complications (systemic) and mortality. Two propensity-weight adjusted analyses were performed 1) comparing hybrid and prosthetic bypass 2) comparing hybrid and vein bypass.
There were 4,478 patients included (1,537 hybrid, 1,408 prosthetic, 1,533 vein); 64.8% were men, and the mean age was 67.8±9.7years; 29.9% had claudication, 38.8% had tissue loss, and 31.